Medical Billing Dispute - What would you do SJ.COM

About four months ago I was went shopping and was fitted for a knee brace.

Not one of those Ace wraps you buy at the local sporting goods store - I'm talking about one of the big honking knee stabilizers that all those NCAA and NFL lineman wear. It was a special brace prescribed to me by my doctor after I had my ACL repaired.

Without it, I can't do any sports that involve a lot of planting, cutting or have any sort of contact. That means no softball, baseball, trail running, flag football, dodgeball (yes I play in a competitive men's travel dodgeball league).

That's why I decided to get the brace. No point paying $7,000 for surgeries and physical therapy if you can't do anything with the knee after, right?

I went to a large orthopedic company that has offices all over the Midwest. They were referred to me by my doctor. When I called them to make an appointment I made the receptionist/nurse/whoever the f answered the phone check that I my insurance was covering the orthotic. She assured me that my copay, and deductable had been met long ago and I didn't have to pay a dime for the brace.

The next morning, when I went to get fitted by the brace, I asked the same woman in person about the cost of the brace. She told me she ran the insurance plan number and information one more time and that I would not owe any money.

Out of curiosity, I asked her what the price of the brace would be anyway. She didn't know, but the person who fitted me for the brace said between $1,000 and $1,200. That matched what I had see online, and what my doctor told me - but it didn't matter - they said it was paid for.

About two weeks later, I picked up my brace and asked for a third and final time if I was going to be charged any money. They told me no. But the woman at the desk, the same receptionist, nurse, whoever the f she was said I had to sign a piece of paper that said I received the brace.

I asked her once more if this meant I had to pay for the brace. She said no. I read the receipt over. It didn't say anywhere that I was on the hook for the price of the brace if the insurance company didn't pay. I took my brace and went on my happy way. I had finally caught a break. After months of rehab and bills, I had my brace and I could finally play basketball again. Just in time for my team's season opener.

I forgot about the whole knee issue, until about two weeks ago, when I got a statement from the insurance company.

In a nutshell, this is what it said: "Orthotic not covered" price $1,528.

I was a bit apprehensive, but I didn't care. It wasn't a bill.

Then today I something else arrived in the mail. A bill from the medical supply company.

It said it was not a covered expense. And I owe them $1,528.

Needless to say, I'm pissed. I was misled and made to believe the brace was covered when it was not. As a result, I had the brace made. I wouldn't have been able to afford it otherwise. If I had been able to afford it, I wouldn't have paid $1,528 for it either. I would have shopped around.

So now I am looking at a hefty bill. More than I should be paying if they would have charged me the estimated price, and a hell of a lot more than I would owe if they wouldn't have told me my insurance was covering it.

I feel like a fool, I should have known better. The company said anything to make a sale and I apparently fell for it. Still, they lied to me numerous times. And I think that is pretty unethical and unacceptable. I'm going to raise hell tomorrow. Followed by telling them they can have their slightly used brace back instead of payment.
ARGHHHHH..... rant over.

On a serious note, I'd try getting a written perscription from your doctor who issued you the knee brace and show that to your insurance company. If you're indeed covered for such expenses, you should show them that and ask them to reimburse you for the $1,528.

On a serious note, I'd try getting a written perscription from your doctor who issued you the knee brace and show that to your insurance company. If you're indeed covered for such expenses, you should show them that and ask them to reimburse you for the $1,528.

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Well the insurance company claims I was not covered for that expense.
The company told me three or more times that I was. That's the problem. I feel like telling the medical company that's their problem, but I know that will lead to a collection agency coming after me.

Seems kinda fishy to me. I'd definitely give the doctor's office hell for giving you wrong information. If you really need the brace, I'd try to talk to your insurance company to see what kind of deal can be worked out so that you can keep your brace without paying the full cost. Sometimes they'll help pay for a portion of it (usually 75%-90%).

Throw the brace through their front window with a copy of the receipt attached, then call your insurance company and ask what avenues you should explore to get something for your knee that falls under your coverage.

Throw the brace through their front window with a copy of the receipt attached, then call your insurance company and ask what avenues you should explore to get something for your knee that falls under your coverage.

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Yeah that brings up even more problems. I've since switched jobs. So the provider at the time of the injury/surgery and met deductibles is different than my insurance now.

The insurance now won't pay for orthotics for previous injuries.

I'm seriously thinking right now, that my best bet will be to return the brace. But then again, it's a used brace, who knows if they will even do that. I just can't afford $1,500 right now.

Especially since I'm being furloughed in two weeks (found out about that furlough 2 weeks after I planned a trip to Vegas) and I ran over a nail and had to get a new back tire. So yeah basically this is the worst possible time for this.

I'm starting to wonder if this shit ever gets any easier. And I still live at home. I can't imagine doing this with a rent payment right now. Although, I wouldn't be at home if I didn't have to stay home from work for months last year and pay 7 grand for medical bills.

And of course that 7 grand for medical bills would have not been as high, if at the time, I wasn't a full-time stringer, and I didn't have to pay for my own shitty insurance.

2. Write a letter to the brace company politely refusing to pay and explaining why (I was assured by your rep that you have verified that the brace was to be covered under my insurance and I would not have purchased the brace otherwise) and send it to the via certified mail, return receipt requested.

3. Monitor your credit monthly. Go ahead and pay the $30 for a 3-in-1 credit report to get with your FICO score and reports from all 3 credit reporting agencies (CRAs), Equifax, Experian, and Trans Union.

4. When the medical company reports your failure to pay for the brace follow the CRAs specified process for disputing certain reports. This should be easy to find on the Net. If necessary, contact the CRAs and provide them with whatever information they request, including a copy of the letter you sent to the brace company.

5. If the reports continue to show a negative reporting item on your credit report contact an attorney who regularly practices in federal court and is familiar with the Fair Debt Collection Practices Act.